mHealth platform improved health worker's compliance to WHO’s IMNCI guideline in Nairobi, Kenya

Abstract   Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya. Key messages • WHO recommended IMNCI compliant mHealth platform enables health care providers to offer quality child health care. • Using mHealth platform to ensure WHO’s IMNCI guideline implementation by health care providers might have potential impact on saving sick children’s lives from preventable deaths.

Poor access to quality health services, especially in urban slums, is a global challenge. Given similar challenges in Nairobi's Kibra informal settlement area, we collaborated with the Langata/Kibra sub-county health management team to conduct a pilot program for improving the quality of child health services delivered by health care providers (HCPs). The pilot introduced a digital mHealth platform to HCPs working in Kibra informal settlement area in Nairobi. This mHealth platform was compliant to WHO's recommended guideline for integrated management of newborn and child illnesses (IMNCI) and was designed to help sick child assessment, diagnosis and management by HCPs. We aimed to determine if using this digital platform, coupled with supportive supervision and community outreach, would lead to improve compliance to the IMNCI guideline for assessment, diagnosis and treatment of sick children. We conducted baseline (February 2019) assessment, trained selected HCPs on the mHealth platform on handheld android tablets, conducted end line (March 2020) and measured any change in HCP's compliance to IMNCI guidelines. Total 89 HCPs were the mHealth platform users during end line assessment. When asked about the choice of antibiotic for treating childhood pneumonia, we found proportion of HCPs who preferred Amoxycillin dispersible tablet, the recommended treatment for childhood pneumonia, increased from 3% at baseline to 38% at end line. Proportion of HCPs who were aware that antibiotics should NOT be used for the management of simple diarrhea increased from 14% (at baseline) to 50% (at end line). At end line, more than 90% HCPs were found compliant in their practice to IMNCI guidelines for sick child assessment, diagnosis and management. These results demonstrate the use of the IMNCI compliant mHealth platforms as a potential important effective way to improve capacity and compliance among HCPs who are serving communities like Kibra informal settlement in Nairobi, Kenya.

Background:
Digitalization has increased rapidly in health and social care and plays an increasingly important role in the daily work of health and social care professionals. The effects of digitalization are often viewed from the societal and economic perspectives, and less from the perspective of the changing health and social care work. This study examined how health and social care professionals perceive the effects of digitalization on their work.

Methods:
Eight semi-structured focus-group interviews were conducted in four Finnish health centers at the end of 2020. The participants (n = 30) were nurses, physicians, and social workers. Qualitative content analysis with inductive approach was used to analyze the data.

Results:
Four main categories emerged from the perceived effects of digitalization: 1) two-way changes in workload and pace (reduced/increased work, accelerated/slowed pace of work, duplication of work/saved employee resources), 2) changes in the content and nature of work (reallocation of work, emergence of new tasks, new skills needs, diversification of service provision), 3) changes in work community communication and interaction (improved interaction and communication, strengthened multidisciplinary collaboration, complicated remote interaction, reduced encounters) and 4) improved flow of patient information and information security (improved data transfer, patient monitoring and data protection).

Conclusions:
Digitalization-induced changes in health and social care work seem to be manifold and often two-sided. It has the potential to ease the work and offer other benefits, but at the same time it may complicate work in other respects, especially if the system does not support work tasks or the usability is poor. When implementing new digital services and pursuing benefits, more attention should be paid to assessing and considering the potential disadvantages to minimize additional strain among already burdened health and social care professionals.

Key messages:
The perceived effects of digitalization on health and social care work are often two-sided and can contribute to the well-being of professionals.
Monitoring the use of digital services and the experiences of professionals about them, as well as identifying their skills needs and training aspirations is crucial.
iii172 European Journal of Public Health, Volume 32 Supplement 3, 2022